A Multiple Component Intervention to Assist Young Pregnant Smokers to Cease Smoking: A Randomised Controlled Pilot Study

Objective: Australian rates of cigarette smoking are the lowest in the world. Young pregnant smokers are a sub population where smoking remains high. This pilot study assessed the feasibility of a multi-component intervention (Carbon Monoxide testing, motivational interviewing and a non-smoking buddy) to assist young pregnant women to cease smoking. Methods: Between October 2013 and June 2015, this multi-centred West Australian study recruited pregnant smokers aged 16 to 24, attending their first antenatal visit. Women (n=80) were randomised to the intervention and standard smoking cessation advice (n=43) or standard smoking cessation advice alone (n=37). At 36 weeks gestation and six weeks post birth, cessation rates were compared between groups using repeated measures survival analysis and reduction in smoking was examined using repeated measures linear regression on the number of cigarettes smoked. Results: The majority (89%) of women were unemployed or not in education, used illicit drugs (43%) and had experienced sexual abuse (23%). Involvement with child protection services was common (38%). Cigarette initiation occurred at a mean age of 13 years, median number of cigarettes smoked at baseline was 10 in both groups. Smoking cessation in intervention and controls were 17% vs. 14% at 36 weeks and 23% vs. 7% 6 weeks post birth. No significant differences in cessation or smoking reduction between groups were found individually or in the repeated events analysis. Conclusion: Given the low number of participants our findings cannot conclusively rule out this multi-component intervention. We believe it remains possible this intervention may prove effective in a larger group of participants and in another setting. Monitoring trends in this vulnerable, difficult to engage group of pregnant young women is important if we are to continue to devise effective interventions

An Exploration of Young Australian Women's Smoking Cessation Goals across the Trajectory of Pregnancy and Post Birth

Objective: Young pregnant women are more likely than other pregnant women to smoke tobacco during pregnancy and post birth. This study explored young women’s perceptions of the factors which impact their smoking cessation goals throughout pregnancy and post birth. Methods: This qualitative descriptive study was performed at two metropolitan obstetric hospitals in Western Australia. Forty three women aged 16 to 24 years old who reported smoking tobacco at their first antenatal visit were interviewed at each scheduled antenatal visit and every two weeks up to six weeks post birth. Interviews were subjected to thematic analysis. Results: A total of 244 interviews were performed; a mean of six interviews per woman (four in pregnancy and two post birth). Four overarching themes across three time periods were identified: the baby; the social bond of smoking; the chaotic nature of life; and access to social support. Pregnant women had a foetus-centric approach to cessation. Post birth those who sustained cessation held this belief for their newborn, whilst those who relapsed did not. The social bond of smoking highlighted smoking as the norm. Initially, women sought out non-smokers to support them. A partner’s smoking status post birth appeared pivotal to remaining tobacco free. The chaotic nature of life, reflected through multiple stressful, negative events, challenged women in achieving their smoking cessation goals. Women who sought social support appeared to stay smoke free post birth. Conclusion: The longitudinal nature of this study provides new insight into complex issues faced by this marginalised group of young, pregnant, tobacco smokers throughout the journey of pregnancy and post birth. Findings enhance our understanding of the complex real life issues some young pregnant Australian smokers face and may be considered when women focused smoking cessation interventions are developed

Predictors of Bicuspid Aortic Valve-Associated Aortopathy in Childhood: A Report From the MIBAVA Consortium

BACKGROUND: Bicuspid aortic valve (BAV) is the most prevalent congenital heart defect affecting 1% to 2% of the population. It is associated with ascending aorta dilatation. Valve morphology, aortic stenosis (AS), and aortic insufficiency (AI) have been proposed as potential risk factors; however, evaluating their role is difficult, as these factors are inherently related. The aim of this study was to determine whether BAV morphology and dysfunction are independent determinants for ascending aorta dilatation in pediatric patients. METHODS: A multicenter, retrospective, cross-sectional study of pediatric BAV patients followed since 2004 was performed. Imaging data were assessed for BAV morphology, severity of AS and AI, history of coarctation, and aortic dimensions. Associations were determined using multivariable regression analysis. A subset of patients undergoing aortic interventions (balloon dilation or Ross) were assessed longitudinally. RESULTS: Data were obtained from 2122 patients (68% male; median age 10.2 years). Fifty percent of patients had ascending aorta dilatation. Right and noncoronary cusp fusion, increasing AS and AI, and older age were independently associated with ascending aorta dilatation. A history of coarctation was associated with less ascending aorta dilatation. In patients with neither AS nor AI, 37% had ascending aorta dilatation (4% severe). No complications related to aortic dilatation occurred in this cohort. Aortic CONCLUSIONS: In this large pediatric cohort of patients with BAV, valve morphology, AS, and AI are independently associated with ascending aorta dilatation, suggesting that hemodynamic factors influence aortopathy. However, even in BAVs with no AS or AI, there is significant ascending aorta dilatation independent of valve morphology. Interventions that led to changes in degree of AI and AS did not seem to influence change in aortic dimensions. The current BAV cohort can be used as a reference group for expected changes in aortic dimensions during childhood

Assessment of the In Vivo Toxicity of Gold Nanoparticles

The environmental impact of nanoparticles is evident; however, their toxicity due to their nanosize is rarely discussed. Gold nanoparticles (GNPs) may serve as a promising model to address the size-dependent biological response to nanoparticles because they show good biocompatibility and their size can be controlled with great precision during their chemical synthesis. Naked GNPs ranging from 3 to 100 nm were injected intraperitoneally into BALB/C mice at a dose of 8 mg/kg/week. GNPs of 3, 5, 50, and 100 nm did not show harmful effects; however, GNPs ranging from 8 to 37 nm induced severe sickness in mice. Mice injected with GNPs in this range showed fatigue, loss of appetite, change of fur color, and weight loss. Starting from day 14, mice in this group exhibited a camel-like back and crooked spine. The majority of mice in these groups died within 21 days. Injection of 5 and 3 nm GNPs, however, did not induce sickness or lethality in mice. Pathological examination of the major organs of the mice in the diseased groups indicated an increase of Kupffer cells in the liver, loss of structural integrity in the lungs, and diffusion of white pulp in the spleen. The pathological abnormality was associated with the presence of gold particles at the diseased sites, which were verified by ex vivo Coherent anti-Stoke Raman scattering microscopy. Modifying the surface of the GNPs by incorporating immunogenic peptides ameliorated their toxicity. This reduction in the toxicity is associated with an increase in the ability to induce antibody response. The toxicity of GNPs may be a fundamental determinant of the environmental toxicity of nanoparticles